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Case Studies

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Asked: Jun 21st, 2019

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Question Description

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

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Inflammatory Bowel Disease
Case Study
The patient is an 11-year-old girl who has been complaining of intermittent right lower
quadrant pain and diarrhea for the past year. She is small for her age. Her physical
examination indicates some mild right lower quadrant tenderness and fullness.
Studies
Hemoglobin (Hgb),
Hematocrit (Hct),
Vitamin B12 level,
Meckel scan,
D-Xylose absorption,
Results
8.6 g/dL (normal: >12 g/dL)
28% (normal: 31%-43%)
68 pg/mL (normal: 100-700 pg/mL)
No evidence of Meckel diverticulum
60 min: 8 mg/dL (normal: >15-20 mg/dL)
120 min: 6 mg/dL (normal: >20 mg/dL)
Lactose tolerance,
Small bowel series,
No change in glucose level (normal: >20 mg/dL rise in
glucose)
Constriction of multiple segments of the small intestine
Diagnostic Analysis
The child's small bowel series is compatible with Crohn disease of the small intestine.
Intestinal absorption is diminished, as indicated by the abnormal D-xylose and lactose
tolerance tests. Absorption is so bad that she cannot absorb vitamin B12. As a result, she has
vitamin B12 deficiency anemia. She was placed on an aggressive immunosuppressive
regimen, and her condition improved significantly. Unfortunately, 2 years later she
experienced unremitting obstructive symptoms and required surgery. One year after surgery,
her gastrointestinal function was normal, and her anemia had resolved. Her growth status
matched her age group. Her absorption tests were normal, as were her B12 levels. Her
immunosuppressive drugs were discontinued, and she is doing well.
Critical Thinking Questions
1. Why was this patient placed on immunosuppressive therapy?
2. Why was the Meckel scan ordered for this patient?
3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s
Disease? (always on boards)
4. What is prognosis for patients with IBD and what are the follow up recommendations for
managing disease?
Urinary Obstruction
Case Studies
The 57-year-old patient noted urinary hesitancy and a decrease in the force of his urinary
stream for several months. Both had progressively become worse. His physical examination
was essentially negative except for an enlarged prostate, which was bulky and soft.
Studies
Routine laboratory studies
Intravenous pyelogram (IVP)
Uroflowmetry with total voided
flow of 225 mL
Cystometry
Electromyography of the pelvic
sphincter muscle
Cystoscopy
Prostatic acid phosphatase
(PAP)
Prostate specific antigen (PSA)
Prostate ultrasound
Results
Within normal limits (WNL)
Mild indentation of the interior aspect of the bladder,
indicating an enlarged prostate
8 mL/sec (normal: >12 mL/sec)
Resting bladder pressure: 35 cm H2O (normal: <40 cm H2O)
Peak bladder pressure: 50 cm H2O (normal: 40-90 cm H2O)
Normal resting bladder with a positive tonus limb
Benign prostatic hypertrophy (BPH)
0.5 units/L (normal: 0.11-0.60 units/L)
1.0 ng/mL (normal: <4 ng/mL)
Diffusely enlarged prostate; no localized tumor
Diagnostic Analysis
Because of the patient’s symptoms, bladder outlet obstruction was highly suspected. Physical
examination indicated an enlarged prostate. IVP studies corroborated that finding. The
reduced urine flow rate indicated an obstruction distal to the urinary bladder. Because the
patient was found to have a normal total voided volume, one could not say that the reduced
flow rate was the result of an inadequately distended bladder. Rather, the bladder was
appropriately distended, yet the flow rate was decreased. This indicated outlet obstruction.
The cystogram indicated that the bladder was capable of mounting an effective pressure and
was not an atonic bladder compatible with neurologic disease. The tonus limb again
indicated the bladder was able to contract. The peak bladder pressure of 50 cm H2O was
normal, again indicating appropriate muscular function of the bladder. Based on these
studies, the patient was diagnosed with a urinary outlet obstruction. The PAP and PSA
indicated benign prostatic hypertrophy (BPH). The ultrasound supported that diagnosis.
Cystoscopy documented that finding, and the patient was appropriately treated by
transurethral resection of the prostate (TURP). This patient did well postoperatively and had
no major problems.
Critical Thinking Questions
1.
2.
3.
4.
5.
Does BPH predispose this patient to cancer?
Why are patients with BPH at increased risk for urinary tract infections?
What would you expect the patient’s PSA level to be after surgery?
What is the recommended screening guidelines and treatment for BPH?
What are some alternative treatments / natural homeopathic options for treatment?
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Tutor Answer

outline
All the following questions covered
Case 1: Inflammatory Bowel Disease.
Why was this patient placed on immunosuppressive therapy?
Why was the Meckel scan ordered for this patient?
What are the clinical differences and treatment options for Ulcerative Colitis and Crohn's Disease?
What is prognosis for patients with IBD, and what are the follow-up recommendations for
managing disease?
Case 2: Urinary Obstruction
1. Does BPH predispose this patient to cancer?
2. Why are patients with BPH at increased risk for urinary tract infections?
3. What would you expect the patient's PSA level to be after surgery?
4. What is the recommended screening guidelines and treatment for BPH?
5. What are some alternative treatments / natural homeopathic options for treatment?

Running head: MEDICAL CASE STUDIES

1

Medical Case Studies
Student's name
Institution of Affiliation
Date

MEDICAL CASE STUDIES

2

Case 1: Inflammatory Bowel Disease.
Why was this patient placed on immunosuppressive therapy?
The patient faces the condition of reduced absorption in the small intestines. She risks his
immune system attacking his own body tissues as vitamin B12 lacks in his blood. With the patient's
condition, he is at risk of contracting the autoimmune disease. Where the immune system tends to
attack the body's own tissues (Graff, Walker & Bernstein, 2009), immunosuppressant drugs will
help weaken the immune system; hence, they help suppress the reaction. With time, the patient is
progressively seen to recover from his condition. In addition, the drugs will help prevent the child
from contacting Technetium-99m through her veins. The substance contains radioactive material
(Carter, Lobo & Travis, 2004).
Why was the Meckel scan ordered for this patient?
During the development of the digestive system in a child, a small part of the system forms
up which becomes part of the small intestine sometimes the body does not get rid of the duct in
the early stages of development. An aspect that may lead in the development of a pouch which
may cause bleeding for the patient. Based on the patient's characteristics, it is important for a
Meckel scan to be conducted on the child to help find abnormal tissues (Car...

Tutor went the extra mile to help me with this essay. Citations were a bit shaky but I appreciated how well he handled APA styles and how ok he was to change them even though I didnt specify. Got a B+ which is believable and acceptable.